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Home My WebLink About330927 10/09/18 (��,q3'( CITY OF CARMEL, INDIANA VENDOR: 362110 ONE CIVIC SQUARE BRIAN TOLAN CHECK AMOUNT: $*******230.00* 19 �_�; CARMEL, INDIANA 46032 608 S UNION ST CHECK NUMBER: 330927 M,�TON�. WESTFIELD IN 46074 CHECK DATE: 10/09/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 REIMB 230.00 OTHER EXPENSES VOUCHER NO. 182955 WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev 1995) ALLOWED 20 Vendor # 362110 IN SUM OF$ ACCOUNTS PAYABLE VOUCHER TOLAN, BRIAN CITY OF CARMEL CARMEL WATER An invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by whom, rates per day, number of hours,rate per hour, numbers of units, price per unit,etc. Payee 230.00 362110 Purchase Order No. ON ACCOUNT OF APPROPRATION FOR TOLAN, BRIAN Terms Carmel Water Utility CARMEL WATER Due Date BOARD MEMBERS I hereby certify that that attached invoice(s), ' or bill(s)is(are)true and correct and that PO# ACCT# the materials or services itemized thereon for DATE INVOICE# Description DEPT# INVOICE# Fund# AMOUNT which charge is made were ordered and DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 11840 01-6200-03 $200.00 and received except 10/3/2018 11840 $200.00 WT062953 01-6040-03 $30.00 10/3/2018 WT062953 $30.00 I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 Cost distribution ledger classification if claim paid motor vehicle highway fund. 20_ Clerk Treasurer Stout's Footwear Est. 1886 13155 N Meridian Street Carmel, IN 46032 Phone: (3,17) 848-5432 10/2/2018 01:27 PM 2/13b/11840 417-5063 BRIAN TOLAN 3450 W. 131ST STREET WESTFIELD, IN 46074 Special Order Pickup by 13b:Klimenko, Sara MILWAUKEE ST WP BRN, in BROWN Coupon: 50.00 OFF COUPON -50.00 Net Price 269.90 Previous Payments 0.00 Payment 269.90 Subtotal: 269.90 Total: 269.90 1 - Cash 270.00 Change: 0.10 Items Sold: 2 A You Saved m� $50.00! `Vn No Refund after 30 days V No Refund on worn, altered, clearance Manufacturer defects warranted for 1 year Like us on Facebook 272566/710.. 3934 . BRIAN SJOLAN 6840 S COUNTY ROAD 750.E KIRKLIN,IN 46050-9415 DATE MAY t5'"26"S'. $ Co PAY TO THE. '[� �A, i OF JUIQt'" ^"�y[' �• I ORDER OF I i E l A01 ,4�� DOLLARS u' P V ®' i9 BMO Harris Sank 9M0HarrisBank N.A. ° Chicago,Illinois Q ` ��y� p RT..• MEMO Ek(AL`1V{ O(oZ./S� x:0.7 i10 2566 in L50Q43386►�'. "03_9.34 , I May 29,2018 Your Drinking Water Operator certification,number WT062953,is enclosed. IMPORTANT CERTIFICATION INFORMATION r ADDRESS CHANGE: It is your responsibility to notify the Indiana Department of Environmental Management of any change of address. You may e-mail us at rkeslaraidem.in.gov or fax to(317)234-7462 or call(317)234-7431. NAME CHANGE: A name change request must be submitted in writing. Mail to:Indiana Department of Environmental Management,Office of Water Quality,Drinking Water Branch-Mail Code 66-34, 100 N.Senate Ave., Indianapolis,IN 46204-2251—or you can fax to(317)234-7462. CERTIFICATION RENEWAL-The Drinking Water Operator Certification Program will forward a certification renewal notice to the certified operator and address provided no later than thirty days prior to the expiration of your certification. - 1 1 DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, Drinking Water Branch` Mui Code 66-341! j Your certification will expire on 06/30/2021. If you have 100 N.Senate Avenue,' I ve any i Indianapolis,IN 46204-2251 questions,please contact Ruby Keslar at(317)234-7431 or email rkeslar(Ltidem.in. ov.'CertificateNuiriber . ` E iration Date ;� ' j; WT0629" ` ,06/30/2021 " r Brian S.Tolan is qualified as'_ Grade WT3 lWater Treatment',Plant Operator s o k y 04 INDIANA;DEPARTIVIENT OF ENVIRONMENTAL MANAGEMENT > N is Drmking Water Branch.-Mail Code 66 34 I IIS I , I!; s` fe �• j ;� i'' `'� 100 N Senate Avenue's f = Indianapolis,IN 46204 2251 Water Works Operator Certificate This is to certify that ;) 11 - S B T'1 n rlai 1. =� i - _o a I has fulfilled the requirementsfor Certification as required by the Laws of the State I j i of Indiana,and is duly certified as a Grade:WT3 Water Treatment IFlant Operator -_ n:the We of Indiana and is entitled to the nghts and privileges as provided by,_the State of Indiana y j and subject to the powers of revocation.as vested m said Agency i iI 1i i{ II ! In Testimony Witness the Signature of the Commissioner, 11/02/2006 '_' Gertlf cate Number VT,-` 53i Bruno L PigottId ' ;Commissioner` STATE FORM 49122(9-98) y I Indiana Department of Environmental Management 100 N.Senate Avenue Invoice Number: 8796863 a, Mail Code 66-34 Renewal Fee: 30.00 Indianapolis,IN 46204-2251 Money Receipt# (Office Only) Certificate Number: WT062953 May 10,2018 Expiration Date: 06/30/2018 Grade: WT3 Brian S.Tolan 0 010 8 4 Obtained By: Examination 6840 S CR 750 E Kirklin IN 46050 Login: Use the Register a Person option and enter your license(certification)number and registration code ONLY to create your login credentials. Registration Code:216140 INDIANA DEPARTMENT OF_ENVIRONMENTAL MANAGEMENT--_— ..-_ .. Water Works Operator Certifccation Renewal Fee Statement Our records indicate your Water Works Certificate No.WT062953, Grade WT3 for class WT3 Water Treatment Plant expires on June 30, 2018. You are required to obtain 25.00 contact hours of continuing education for renewal; a minimum of 70%must be technical: Our records indicate that you currently have accumulated 38.00 contact hours towards renewal. (This may not reflect hours for courses recently attended.)If you need to verify the number of technical course hours obtained, you may login online using the instructions below. Note: If you have not recently attended an approved course, and you do not have the required number of hours, you need to attend courses prior to June 30,2018. After this date you are on expired status and are not a valid certified operator, and you may not perform any duties as a certified operator. You do have until June 30, 2019 to get your continuing education hours and renew your certification without retesting. Failure to renew by June 30, 2019 will result in termination of your certification, and you will have to retest. Online Renewal–Online renewal is available 24 hours a day, 7 days a week at haps://mylice.nse.in.gov. The cost for the online renewal is$30.00 plus an additional processing fee for each certification renewal. The forms of-payment-accepted online are Visa, Master-Card;Sc.Discover-eredit-and debit cards:-Ike the----- Register a Person option to enter your license(certification)number and registration code(listed above) only to create your login credentials. Mail Renewal–To renew through the mail,please fill out the section on the back of this page and return this entire letter with$30 fee payment to the remittance address listed. Be sure to sign and date in spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take longer than an online renewal. If you have other drinking water certifications due renewal, you can combine them in one mailing with a fee payment that covers all of them. For example: (3 renewals x $30/per renewal)=$90 combined fee. - Remit Payment to: Indiana Department of Environmental Management Drinking Water Branch, OWQ,Mail Code 66-34 100 N. Senate Avenue Indianapolis,IN 46204-2251 (1) Cancel Certification—If you do not want to renew this certification, please write"CANCEL" on this form, sign and date in spaces provided, and mail to the remittance address listed on page 1. FILL OUT & RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING If this certification was obtained by Examination and the facility you are employed at has changed, please add your new employer in the space provided. NOTE—If this certification is Grandfathered or Site Specific,it is valid only for the location below. Operator Number: WT062953 Invoice Number: 8796863 PWS Name PWS ID Carmel Water Department 15229004 SAW Address Change: (0&I yU , CR, 7S 0 E U.l2KL40 ` LAS L16050 Home Phone Number: �1-7 q 17 50(03 Work Phone Number: 3t7 733 2 S 5 Operator Signature: Date: A`r 15. 20-1 (2)